Early prognostic value of the medical emergency team calling criteria in patients admitted to intensive care from the emergency department

OBJECTIVES: To evaluate the early prognostic value of the medical emergency team (MET) calling criteria in patients admitted to intensive care from the emergency department. DESIGN: Retrospective cohort study. SETTING: Emergency department and department of intensive care medicine of a 960-bed tertiary referral hospital. PATIENTS: A total of 452 consecutive adult patients admitted to intensive care from the emergency department from January 1, 2004, to December 31, 2004. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: MET calling criteria were retrospectively extracted from patient records, and the sum of positive criteria was calculated for the first hour in the emergency department (METinitial) and subsequently until admission to the intensive care unit in a series of time periods. The maximum number of positive MET calling criteria during any time period was defined (METmax). Logistic regression analysis revealed METinitial (odds ratio [OR] 3.392, 95% confidence interval [CI] 2.534-4.540) and METmax (OR 3.867, 95% CI 2.816-5.312) to be significant predictors of hospital mortality, the need for mechanical ventilation (METinitial: OR 4.151, 95% CI 3.53-4.652; METmax: OR 4.292, 95% CI 3.151-5.846), and occurrence of hemodynamic instability (METinitial: OR 1.548, 95% CI 1.258-1.905; METmax: OR 1.685, 95% CI 1.355-2.094) (all p < .0001). CONCLUSIONS: MET scores collected early after admission or throughout the stay in the emergency department allow for simple identification of patients at risk of unfavorable outcome during the subsequent intensive care unit stay.

Dusty punch cards and an eternal enigma: high-density lipoproteins and atherosclerosis

Epidemiological, clinical, and experimental evidence has accumulated during the last decades suggesting that high-density lipoproteins (HDLs) may protect from atherosclerosis and its clinical consequences. However, more than 55 years after the first description of the link between HDL and heart attacks, many facets of the biochemistry, function, and clinical significance of HDL remain enigmatic. This applies particularly to the completely unexpected results that became available from some recent clinical trials of nicotinic acid and of inhibitors of cholesteryl ester transfer protein (CETP). The concept that raising HDL cholesterol by pharmacological means would decrease the risk of vascular disease has therefore been challenged.

Assessing Calling in Chinese College Students: Development of a Measure and Its Relation to Hope

Research suggests that perceiving a calling towards a particular career is relatively frequent among college students in Western cultures. However, little is known about how this applies to other cultural contexts. This study assessed the perception of career as a calling in the Chinese culture. Study 1 reports the development of the Chinese Calling Scale (CCS), based on a sample of 788 Chinese college students, and identifies three dimensions of a calling: Altruism, Guiding Force, and Meaning and Purpose. Measurement invariance across gender is supported by the CCS. In Study 2, the convergent and criterion validity of the CSS is examined based on a sample of 387 college students. The CCS is strongly related to an existing calling measure and moderately related to life meaning and life satisfaction. Study 3 examines the relation between calling, hope, life meaning, life satisfaction, and career decidedness among 518 college students. The findings reveal that hope significantly mediated the relation of calling with career decidedness, life meaning, and life satisfaction. In summary, this study provides a new scale to assess calling in Chinese culture and is the first to explore how calling relates to dispositional hope.

Calling and career preparation: Investigating developmental patterns and temporal precedence

The presence of a calling and career development are assumed to be closely related. However, the nature of and reason for this relationship has not been thoroughly investigated. We hypothesized the existence of reciprocal effects between calling and three dimensions of career preparation and assessed the change of the presence of a calling, career planning, decidedness, and self-efficacy with three waves of a diverse sample of German university students (N = 846) over one year. Latent growth analyses revealed that the intercepts of calling showed a siginficant positive correlation with the intercepts of all career preparation measures. The slope of calling was positively related to those of decidedness and self-efficacy but not to planning. Cross-lagged analyses showed that calling predicted a subsequent increase in planning and self-efficacy. Planning and decidedness predicted an incrrease in the presence of a calling. The results suggest that calling and career preparation are related due to mutual effects but that effects differ for different career preparation dimensions.

Vocational identity achievement as a mediator of presence of calling and life satisfaction

The present study explores what mechanism might be responsible for the reported link between presence of a calling in one’s career and life satisfaction. It is proposed that vocational identity achievement acts as one important mediator of this relation and that the effects can be observed even when controlling for core self-evaluations (CSEs). The study used a short-term longitudinal design based on a sample of 269 German college students from different majors. The results confirmed the mediation model, with calling predicting vocational identity achievement 6 months later and identity serving as a stronger predictor of life satisfaction, all controlling for CSEs. However, contrary to previous research, presence of calling was not directly related to life satisfaction and even showed a negative relation when vocational identity achievement was controlled. The results are interpreted to suggest a multifaceted relation between calling and life satisfaction.

Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): multisite comparison of different clinical decision support systems

BACKGROUND: The adequacy of thromboprophylaxis prescriptions in acutely ill hospitalized medical patients needs improvement. OBJECTIVE: To prospectively assess the efficacy of thromboprophylaxis adequacy of various clinical decision support systems (CDSS) with the aim of increasing the use of explicit criteria for thromboprophylaxis prescription in nine Swiss medical services. METHODS: We randomly assigned medical services to a pocket digital assistant program (PDA), pocket cards (PC) and no CDSS (controls). In centers using an electronic chart, an e-alert system (eAlerts) was developed. After 4 months, we compared post-CDSS with baseline thromboprophylaxis adequacy for the various CDSS and control groups. RESULTS: Overall, 1085 patients were included (395 controls, 196 PC, 168 PDA, 326 eAlerts), 651 pre- and 434 post-CDSS implementation: 472 (43.5%) presented a risk of VTE justifying thromboprophylaxis (31.8% pre, 61.1% post) and 556 (51.2%) received thromboprophylaxis (54.2% pre, 46.8% post). The overall adequacy (% patients with adequate prescription) of pre- and post-CDSS implementation was 56.2 and 50.7 for controls (P = 0.29), 67.3 and 45.3 for PC (P = 0.002), 66.0 and 64.9 for PDA (P = 0.99), 50.5 and 56.2 for eAlerts (P = 0.37), respectively, eAlerts limited overprescription (56% pre, 31% post, P = 0.01). CONCLUSION: While pocket cards and handhelds did not improve thromboprophylaxis adequacy, eAlerts had a modest effect, particularly on the reduction of overprescription. This effect only partially contributes to the improvement of patient safety and more work is needed towards institution-tailored tools.

How should complementary and alternative medicine be taught to medical students in Switzerland? A survey of medical experts and students

In Switzerland and in the whole western world, the growing popularity of CAM is calling for its implementation in the undergraduate medical curriculum.

Effects of {beta}-blocker selectivity on blood pressure variability and stroke: A systematic review

β-Blockers increase variability in systolic blood pressure (SBP), which probably explains their lesser effectiveness in preventing stroke vs myocardial infarction compared with other agents. This increase in variability in blood pressure (BP) may be particularly marked on non-cardioselective agents, potentially calling into question the widespread first-line use of propranolol in migraine with aura, elderly patients with essential tremor or anxiety, and other groups at risk of stroke.

Two new rapid SNP-typing methods for classifying Mycobacterium tuberculosis complex into the main phylogenetic lineages

There is increasing evidence that strain variation in Mycobacterium tuberculosis complex (MTBC) might influence the outcome of tuberculosis infection and disease. To assess genotype-phenotype associations, phylogenetically robust molecular markers and appropriate genotyping tools are required. Most current genotyping methods for MTBC are based on mobile or repetitive DNA elements. Because these elements are prone to convergent evolution, the corresponding genotyping techniques are suboptimal for phylogenetic studies and strain classification. By contrast, single nucleotide polymorphisms (SNP) are ideal markers for classifying MTBC into phylogenetic lineages, as they exhibit very low degrees of homoplasy. In this study, we developed two complementary SNP-based genotyping methods to classify strains into the six main human-associated lineages of MTBC, the "Beijing" sublineage, and the clade comprising Mycobacterium bovis and Mycobacterium caprae. Phylogenetically informative SNPs were obtained from 22 MTBC whole-genome sequences. The first assay, referred to as MOL-PCR, is a ligation-dependent PCR with signal detection by fluorescent microspheres and a Luminex flow cytometer, which simultaneously interrogates eight SNPs. The second assay is based on six individual TaqMan real-time PCR assays for singleplex SNP-typing. We compared MOL-PCR and TaqMan results in two panels of clinical MTBC isolates. Both methods agreed fully when assigning 36 well-characterized strains into the main phylogenetic lineages. The sensitivity in allele-calling was 98.6% and 98.8% for MOL-PCR and TaqMan, respectively. Typing of an additional panel of 78 unknown clinical isolates revealed 99.2% and 100% sensitivity in allele-calling, respectively, and 100% agreement in lineage assignment between both methods. While MOL-PCR and TaqMan are both highly sensitive and specific, MOL-PCR is ideal for classification of isolates with no previous information, whereas TaqMan is faster for confirmation. Furthermore, both methods are rapid, flexible and comparably inexpensive.

Delays in childhood immunization in a conflict area: a study from Sierra Leone during civil war

ABSTRACT: BACKGROUND: Sierra Leone has undergone a decade of civil war from 1991 to 2001. From this period few data on immunization coverage are available, and conflict-related delays in immunization according to the Expanded Programme on Immunization (EPI) schedule have not been investigated. We aimed to study delays in childhood immunization in the context of civil war in a Sierra Leonean community. METHODS: We conducted an immunization survey in Kissy Mess-Mess in the Greater Freetown area in 1998/99 using a two-stage sampling method. Based on immunization cards and verbal history we collected data on immunization for tuberculosis, diphtheria, tetanus, pertussis, polio, and measles by age group (0-8/9-11/12-23/24-35 months). We studied differences between age groups and explored temporal associations with war-related hostilities taking place in the community. RESULTS: We included 286 children who received 1690 vaccine doses; card retention was 87%. In 243 children (85%, 95% confidence interval (CI): 80-89%) immunization was up-to-date. In 161 of these children (56%, 95%CI: 50-62%) full age-appropriate immunization was achieved; in 82 (29%, 95%CI: 24-34%) immunization was not appropriate for age. In the remaining 43 children immunization was partial in 37 (13%, 95%CI: 9-17) and absent in 6 (2%, 95%CI: 1-5). Immunization status varied across age groups. In children aged 9-11 months the proportion with age-inappropriate (delayed) immunization was higher than in other age groups suggesting an association with war-related hostilities in the community. CONCLUSION: Only about half of children under three years received full age-appropriate immunization. In children born during a period of increased hostilities, immunization was mostly inappropriate for age, but recommended immunizations were not completely abandoned. Missing or delayed immunization represents an additional threat to the health of children living in conflict areas.

Diel variation in a dynamic sexual display and its association with female mate-searching behaviour

Dynamic sexual signals often show a diel rhythm and may vary substantially with time of day. Diel and short-term fluctuations in such sexual signals pose a puzzle for condition capture models of mate choice, which assume a female preference for male traits that reliably reflect a male's quality. Here we experimentally manipulated the food supply of individual male field crickets Gryllus campestris in their natural habitat in two consecutive seasons to determine (i) the effect of male nutritional condition on the fine-scaled variation of diel investment in acoustic signalling and (ii) the temporal association between the diel variation in male signalling and female mate-searching behaviour. Overall food-supplemented males signalled more often, but the effect was only visible during the daytime. In the evening and the night, signal output was still high but the time spent signalling was unrelated to a male's nutritional condition. Females' mate-searching behaviour also showed a diel rhythm with peak activity during the afternoon, when differences among calling males were highest, and where signal output reliably reflects male quality. These findings suggest that males differing in nutritional condition may optimize their investment in signalling in relation to time of day as to maximize mating success.

Long-term systemic administration of human recombinant interleukin-1beta induces a dose-dependent fall in circulating parathyroid hormone in rats

The synergism/antagonism between interleukin (IL)-1beta and parathyroid hormone (PTH) has been the subject of in vitro and in vivo work, but a possible direct action of the cytokine on PTH release has not been reported. We have investigated the effect of a continuous infusion of human recombinant IL-1beta (rIL-1beta) on circulating PTH during a 14-day period in 7-week-old female rats. This time interval was chosen in order to exclude initial hypercalcemia and to enable data collection under steady-state conditions. Five groups of 20 animals each had miniosmotic pumps (Alzet 2002, 200 microl) implanted subcutaneously and primed to release either distilled water (controls) or 100, 500, 1,000 and 2, 000 ng/24 h of rIL-1beta. Blood was drawn on days 1 and 14 for PTH, corticosterone and Ca2+ determinations. Adequate biological activity of the infused rIL-1beta was supported by elevated rectal temperature records and significant elevations of plasma corticosterone on day 14. The 100-ng dose had no effect but 500-2, 000 ng rIL-1beta/24 h significantly reduced plasma PTH in a dose-dependent manner down to 54% of basal value (20.4 +/- 1.1 vs. 15.3 +/- 1.4 pg/ml for 500 ng, p < 0.005; 20.5 +/- 1.3 vs 12.3 +/- 1.1 for 1,000 ng, p < 0.001, and 19.5 +/- 2.0 vs. 10.6 +/- 1.1 pg/ml for 2,000 ng, p < 0.0008). Despite these findings, no differences in blood Ca2+ could be detected between treated animals and controls. The following conclusions can be inferred from the foregoing: Systemic administration of rIL-1beta to rats induced a dose-dependent fall in circulating PTH without altering calcemia, calling into question the biological relevance of the former finding. Although the recorded PTH depression may indeed not have been severe enough to cause hypocalcemia, it can be hypothesized that osteoclast activation by rIL-1beta would enhance bone mineral release into the pool compensating for depressed PTH activity.